Claims Processing Solution (CPS)
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IMPORTANT INFORMATION+ Tariff Authorization Application Form – July 1, 2024
+ Family Medicine Plus – ICD Code Resource for Chronic Disease Clusters – April 1, 2024
+ Tariff 8700 - ICD Code Resource: Continuing Patient Care Management by Medical Specialists – April 1, 2024
+ COVID-19 Vaccine Tariff Information – Apr. 1, 2023
+ COVID-19 Vaccine Tariff Information – Dec. 1, 2022
Effective October 8, 2022, the Minister of Health has authorized a time-limited tariff to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below: Effective September 19, 2022, the Minister of Health has authorized the above time limited tariff to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. Effective September 1, 2022, the Minister of Health has authorized the above time limited tariff to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. Effective July 15, 2022, the Minister of Health has authorized the above time limited tariff to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. Effective April 1, 2022, the Minister of Health has authorized a time-limited tariff for the administration of the Novavax vaccine, to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. Effective November 5, 2021, the Minister of Health has authorized time-limited tariffs to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. Effective July 12, 2021, the Minister of Health has authorized a time-limited tariff for COVID-19 Immunization Hesitancy Advice, to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. Effective April 26, 2021, the Minister of Health has authorized the time-limited tariffs for the administration of the Pfizer vaccine and the Moderna vaccine, to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below.
Effective February 1, 2021, the Minister of Health has authorized the time-limited tariff for the administration of the Astra-Zeneca vaccine, to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. + COVID-19 Rapid Antigen Test and PCR Test Tariff Information – March 1, 2022
Effective March 1, 2022, the Minister of Health has authorized two time-limited tariffs for the Rapid Antigen Test (RAT) and the Nasopharyngeal Swab for Polymerase Chain Reaction (PCR) test, to be paid during the COVID-19 pandemic response in Manitoba (the duration of the tariff herein to be determined by Manitoba). Please refer to the additional information below. + Time Limited Virtual Visit Tariffs Available During the COVID-19 Pandemic Response – Nov. 1, 2020
Effective March 14, 2020, the Minister of Health has authorized the following time limited tariffs to be paid during the COVID-19 pandemic response in Manitoba, the duration of these time limited tariffs to be determined by Manitoba. These tariffs are to be claimed for virtual visits that are provided in place of in-clinic visit services, and are not deemed to be included in the Manitoba Physician's Manual. Effective April 24, 2020, the Minister of Health has authorized the following time limited tariffs to be paid during the COVID-19 pandemic response in Manitoba, the duration of these time limited tariffs to be determined by Manitoba. These tariffs are to be claimed for virtual visits that are provided in place of in-clinic visit services, and are not deemed to be included in the Manitoba Physician's Manual.
Effective November 1, 2020, the Minister of Health has authorized the following time limited tariffs to be paid during the COVID-19 pandemic response in Manitoba, the duration of these time limited tariffs to be determined by Manitoba. These tariffs are to be claimed for virtual visits that are provided in place of in-clinic visit services, and are not deemed to be included in the Manitoba Physician's Manual. + ICD-9 Codes to use for medical claims for patients with suspected or diagnosed COVID-19 – March 30, 2020
To help with monitoring, please use the following ICD-9 Codes for medical conditions related to COVID-19:
*Temporary Manitoba descriptor interpretations, effective November 2019 + Updates to Provincial Data Systems: Potential Impact to Claims for Comprehensive Care Management (CCM) Benefits – Dec. 1, 2019
Home Clinic enrolment processing will be impacted as Digital Health makes required updates to provincial data systems. From December 4th – 11th, 2019 all enrolment processing will be paused as we make these updates. The processing of enrolments will resume on December 12th, 2019. Two days of Comprehensive Care Management (CCM) benefit claims may be impacted by the timing of this process.
If you have questions regarding your CCM claims, please contact the Claims Unit General Line at 204-786-7355. + Addition of a New Special Circumstance Indicator – Nov. 1, 2019
A new Special Circumstance Indicator "N" has been added regarding the amendment to Rule of Application 42 – Open Reduction. The special circumstance indicator "N" should be used when submitting a claim for an additional 25% of the listed fracture benefit by an orthopaedic surgeon for open reduction of a fracture with a demonstrated radiographic Non-Union after 16 weeks from the date of the initial fracture. + Diagnostic Ordering by Designated Registered Nurses – June 1, 2018
Effective May 31, 2018, a generic billing number has been added under bloc 115 to allow diagnostic ordering by diagnostic registered nurse (RN) providers. Laboratory and radiology services ordered by RN providers must be submitted using the generic billing number in the referring provider field. For information or assistance with respect to claim submissions may contact the Claims Unit – Claims Enquiry at 204-786-7355 or Toll free at 1-800-392-1207 Ext. 7355. + Change to Billing of Date Span Benefits – June 1, 2018
In an effort to expedite claims processing and eliminate queries required for date span benefits, Manitoba Health (Health) will require that claims for date span benefits be submitted for each day on a separate line on the claim. Separate claims for each day will also be acceptable. The benefits affected are: Currently, if there is an interfering claim for 1 day of a date span benefit and the date span benefit is for 30 days, the entire date span period will either reject or pend. By billing each day on a separate line, 29 days can be paid without manual intervention and we can also automate processing of the day that has an interacting benefit, resulting in expedited processing of the entire claim. This change will be in effect for any claims with June 1, 2018 (and onward) service dates. Any claims billed with June 1, 2018 service dates for the above benefits should be billed as 1 day/service per line item. Claims billed for multiple days on 1 line only, starting with June 1, 2018 dates of service onward, will be reduced to 1 service and paid for 1 day with EOB 1C “The number of services has been adjusted to reflect the maximum allowed.” + CCM and CDM Billing Information - Updated August 1, 2017
Effective April 1, 2017, five new Comprehensive Care Management (CCM) benefit codes (tariffs) will be added to the Manitoba Physician’s Manual. The complete tariff descriptions can be found here. EOB 4Y - The Passive Enrolment Solution for CCM ClaimsAn issue was uncovered that impacted claims from clinics who passively enrolled their patients, and had their first Primary Care Data Extract (PCDE) bulk upload to the Home Clinic Portal after April 1, 2017. The Home Clinic Portal was designed to set the passive enrolment start date equal to the date the extract was processed. Example: If a clinic submitted a CCM claim with a service date of April 1, 2017, but didn't submit their bulk enrolment until April 10, 2017, the CCM claim would have rejected with the following explanation of benefit (EOB) code: A solution has been implemented for this passive enrolment issue, and eligible claims previously rejected solely with EOB 4Y will be re-processed, starting with the August 15, 2017 remittance advice statement. To ensure all eligible claims are processed, we will monitor and re-process these particular claims over the next few remittance advice statements. It is important to note that incoming CCM claims (for passively enrolled patients) that have dates of service prior to the date the PCDE bulk upload was made to the Home Clinic Portal, may still reject with EOB 4Y. On a go forward basis, if a claim is submitted for a passively enrolled patient, and the claim is subsequently rejected with EOB 4Y because of the scenario described above, please wait 2 remittance advice statements for us to re-process eligible claims. If your previously rejected claim(s) with EOB 4Y has not been re-processed for payment within 2 remittance advice statements, an enrolment by another physician for that patient may have occurred. To inquire further, please contact the Home Clinic team at 204-926-6010, or 1-866-926-6010, or homeclinic@manitoba-ehealth.ca with your enrolment question. You can also visit their website at www.manitoba-ehealth.ca/emr-hclinic.html. They will be able to assist you with your enrolment questions. Any other CCM claim rejections where the physician believes they have met all the criteria of the CCM benefit(s), should submit a query with explanation and supporting documentation (if available), to the Claims Unit for review. Important information and billing tips for Comprehensive Care Management (CCM) tariffs:
- posted March 23, 2017 + Billing Bulletins - November 10, 2016
The Billing Bulletin provides billing guidance when submitting claims to Manitoba Health, Seniors and Active Living (Health) for tariffs regarding interventional cardiology found in the Cardiovascular System section of the Manitoba Physician’s Manual (the Physician’s Manual). The Physician’s Manual is the authoritative reference when submitting medical claims to Health. The Billing Bulletin reflects the Surgical Rules of Application and Notes set out in the Physician’s Manual. For ease of reference the tariffs have been grouped into categories. + Important Updates to the Primary Caregiver Tax Credit - October 21, 2016
The Primary Caregiver Tax Credit is an annual refundable personal income tax credit that can be claimed by any Manitoban who is providing ongoing voluntary care to a family member, a friend or a neighbour in Manitoba. The PCGTC rate can be found at: www.gov.mb.ca/finance/tao/caregiver.html The care recipient must be assessed by the Regional Health Authority (RHA), Department of Families or a health care professional (e.g. nurse, social worker, occupational therapist, physiotherapist or physician), as requiring the equivalent of Home Care Level of Care 2, 3 or 4. A revised Level of Care Equivalency Guide form has been created. The revised form:
As of May 1, 2016 the revised Level of Care Equivalency Guide must be used and can be found at: www.gov.mb.ca/finance/tao/caregiver.html Please destroy any old forms that may be available in your offices.+ Start or Start & Stop Time - September 14, 2015
START or START & STOP TIMEThe use of the Start and Stop Time fields without unnecessary remarks will expedite claims adjudication. 24-Hour Format. “START” or “START & STOP” times must be entered in a 24-hour format, for example 11:30 p.m. is entered as 23:30. 24:00 and 00:01 are appropriate entries; however 24:01 or 00:00 are not valid start or stop times. + Bilateral / Incision Indicator Field - April 22, 2015
Valid values for this field on the new CPS are as follows:
The Bilateral/Incision Indicator field must be blank when not applicable. The Bilateral/Incision Indicator field should be used when submitting claims for procedures performed bilaterally (at the same sitting) and to indicate when multiple procedures are performed through the same or separate incisions. The use of this field without adding unnecessary remarks will expedite claims adjudication. ...MORE + Chronic Disease Management (CDM) - April 22, 2015
The options for submitting your patient care treatment forms for general practitioners in fulfilling the requirements for billing benefit codes (tariffs) 8431, 8433, 8434 and 8435. + PHIA On Line Training Sessions - December 16, 2014
The Personal Health Information Act (PHIA) requires all health information trustees, including health care facilities (ex: medical clinics and laboratories), health services agencies and privately practicing licensed, registered or designated health professionals to be familiar with PHIA and to develop policies and procedures as required by the Act. To assist trustees in complying with the many requirements of this law, Manitoba Health (Health) has developed a PHIA Online Training Program. This program provides a comprehensive review of The Personal Health Information Act (PHIA) and offers the following three versions free of charge... + Six (6) month deadline for claims submissions, including re-submissions - November 5, 2014
What will happen to claims submitted past the 6-month time frame? Manitoba Health (Health) provides coverage for insured medical services in accordance with The Health Services Insurance Act and its regulations. Section 4(2) of the Medical Services Insurance Regulation 49/93 states: Claims (including re-submitted claims) received by Health more than 6 months after the service date will be rejected with Explanation of Benefits (EOB) code C2 This claim was refused as this service was not submitted within 6 months from the date on which the service was rendered. ...MORE + ICD-9-CM Codes
The requirement of a valid ICD-9 CM code affects MEDICAL (Physician and RN(EP)), DENTAL (Oral Surgery) and Optometric claims only. + What is a Remittance Advice? - August 29, 2014
A Remittance Advice is the electronic information file that Health provides each pay period to assist you with reconciling your claims in your practice management systems. The remittance file is available for download from Health beginning on the 3rd business day after the electronic claim cut-off date until the next cut-off. Each remittance file must be downloaded by your billing staff. The decision regarding the information you wish to extract from the remittance file should be made by you and your billing software vendor or service bureau. The list below shows the type of information that Health reports back to providers on the Remittance Advice file each pay period. If there are items in the list below that you would like to see on your reports, please contact your vendor to discuss. ...MORE + Personal Health Identification Number (PHIN) - August 29, 2014
What patient demographic information is required in CPS? Every claim should have the following six (6) fields correctly completed for patient demographics:
The PHIN is a mandatory field on all claims. If the PHIN is not correctly entered on the claim, it will be rejected. ...MORE |
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Questions?
If you have questions, please contact our Claims Unit General Line at 204-786-7355.
